Claims Examiner

Prime Healthcare•Victorville, CA

17d•Onsite

About The Position

The Claims Examiner reviews and adjudicates routine and non-routine healthcare claims for Desert Valley Medical Group in Victorville, California. The role evaluates claims for accuracy and completeness, applies established claims policies, procedures, and processing standards, and resolves discrepancies. The examiner is expected to process claims accurately and within established timelines while maintaining accurate documentation and meeting quality expectations. This is a full-time, weekday, day-shift position in the Claims department.

Requirements

At least 2 years of healthcare claims experience; the qualifications section specifies 2–3 years of relevant healthcare claims and customer service experience.
Strong attention to detail and analytical skills.
Ability to interpret and apply policies and procedures.
Strong organizational and problem-solving skills.
Knowledge of medical terminology and medical insurance.
Computer literacy.

Nice To Haves

High school diploma or GED preferred.

Responsibilities

Review and adjudicate routine and non-routine healthcare claims.
Evaluate claims for accuracy, completeness, and appropriate processing.
Apply established claims standards, policies, procedures, and processing standards.
Research and resolve claim discrepancies.
Process claims accurately, in a timely manner, and according to set standards.
Meet established processing timelines and quality expectations.
Maintain accurate claims documentation.

Benefits

Comprehensive benefits for eligible employees, with options to tailor benefits to individual needs.
Paid time off.
Paid holidays.
401(k) retirement plan.
Medical coverage.
Dental coverage.
Vision coverage.
Tuition reimbursement.
Professional development opportunities.
Career growth opportunities.
Voluntary benefit options.
Supportive and collaborative work environment.